Provider Demographics
NPI:1457906026
Name:WALZ, STEPHANIE LEEANN (AGNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEEANN
Last Name:WALZ
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEEANN
Other - Last Name:WESTFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG, 5TH FL
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-4121
Mailing Address - Fax:317-880-0343
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:FIFTH THIRD BANK BLDG, 5TH FL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-4121
Practice Address - Fax:317-880-0343
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209559A163W00000X
IN71009394A363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology